The Federal Government sets strict guidelines about the examinations that are performed by Hunter Imaging Group and which of these will attract a Medicare Rebate.
See below for criteria about specific examinations and the physicians that can refer for various medical imaging services.
If you have any more queries about the Medicare Benefits Schedule in relation to our examinations then please contact Doctor Direct on (02) 4925 5451 or any of the Client Services Team.
Greater Access for Patients to Medicare Eligible MRI.
In addition to the GP MRI Paediatric items announced in 2012, the Federal Government have extended MRI Medicare eligibility to General Practitioner referred patients who are 16 years or older.
Four new items have been added to theMedicare Benefits Schedule (MBS) for certain regions and clinical conditions. The table below summarises the four new items along with the paediatric items and the clinical conditions required by Medicare.
Table 1: The new General Practitioner Referred MRI Regions and associated clinical criteria
Patients 16 Years or Older
Region | Criteria |
---|---|
Head |
|
Cervical Spine 1 |
|
Cervical Spine 2 |
|
Knee |
|
Patients <16 years
Region | Criteria |
---|---|
Head |
|
Spine |
Following radiographic examination for any of the following:
|
Knee | Following radiographic examination for internal joint derangement. |
Hip |
Following radiographic examination of any of the following:
|
Elbow | Following radiographic examination where a significant fracture or avulsion injury is suspected that will change management. |
Wrist | Following radiographic examination where scaphoid fracture is suspected. |
To view our MRI locations, simply click on either Charlestown, Cardiff or East Maitland.
If you any any questions with regard to these changes, please feel free to speak to one of our specialised MRI Radiologists by phoning Doctor Direct on 4925 5451. Alternatively, send an email to hig.DoctorDirect@sonichealthcare.com.au.
All examinations performed by Hunter Imaging Group are done so under the Medicare Benefits Schedule (MBS). For a patient to be eligible for a Medicare rebate there are certain criteria that all referrals must display.
- Referrer name
- Referrer provider number
- Referrer contact details
- Examination requested
- All relevant clinical history
Hunter Imaging Group provides personalised stationary free of charge to assist our referrers in correctly filling out a referral. If you are interested in receiving personalised request forms please contact our Doctor Direct line.
Hunter Imaging Group charges a different Medicare Item Number for BMD examinations depending on the patient’s clinical history. If the patient does not fit into one of these criteria set by the Medicare Benefits Schedule (MBS) the patient will be charged a private fee and no Medicare rebate will apply.
In addition to the information below Hunter Imaging Group provides specialised tick-box style request pads to our referring physicians. These can be ordered free of charge by calling our Doctor Direct line.
Item number | Criteria |
---|---|
12306 | Performed when:
|
12312 | Performed when:
|
12315 | Performed when:
|
12321 | Performed when:
|
Hunter Imaging Group performs Nuchal Translucency scans in line with the Medicare Benefits Schedule (MBS). For a patient to be eligible for a Medicare rebate they must fit one of the following criteria and the applicable condition must be present and stated on the request form.
- The patient is 12-16 weeks of gestation and referred by a medical practitioner, and
- One or more of the following conditions are present:
- Hyperemesis
- Risk of foetal abnormality
- Previous post dates delivery
- Abdominal wall scarring
- Inflammatory bowel disease
- Advanced maternal age
- Toxaemia of pregnancy
- Significant maternal obesity
- Previous caesarean section
- Suspicion of ectopic pregnancy
- Diminished symptoms of pregnancy
- Previous pelvis or spinal trauma or disease
- Pregnancy after assisted reproduction
- Suspected or known uterine disease
- Suspected or known cervical incompetence
- Diabetes mellitus
- Hypertension
- Autoimmune disease
- Alloimmunisation
- Maternal infection
- Bowel stoma
- Drug dependency
- Thrombophilla
- Abdominal pain or mass
- Liver or renal disease
- Poor obstetric history
- Risk of miscarriage
- High risk pregnancy
- Uncertain dates
- Cardiac disease
Hunter Imaging Group operates three Medicare Eligible MRI scanners located at Cardiff, East Maitland and Tamworth.
At all three of these locations patients who present for a MRI are scanned in accordance with the Medicare Benefits Schedule (MBS). This means for a patient to be entitled to a Medicare Rebate their request must be from a Specialist Physician and comply with specific indications which must be present and stated on the request form.
Below are a list of the indications for the scans performed by Hunter Imaging Group:
Anatomical Region | Indication |
---|---|
Breast | Magnetic Resonance Imaging performed under the professional supervision of an eligible provider at an eligible location where the patient is referred by a specialist or by a consultant physician and where;
Scan of both breasts for:
|
Head |
Unlimited referrals:
Benefits payable for each service on 3 occasions in 12 months:
|
Head and neck vessels |
Benefits payable for each service on 3 occasions in 12 months:
|
Head and cervical spine |
Unlimited referrals:
Benefits payable for each service on 3 occasions in 12 months:
|
Spine – one region or two contiguous regions |
Unlimited Referrals:
Benefits payable for each service on 3 occasions in 12 months:
|
Spine – three contiguous regions or two non-contiguous regions |
Unlimited Referrals:
Benefits payable for each service on 3 occasions in 12 months:
|
Cervical spine and brachial plexus |
Benefits payable for each service on 3 occasions in 12 months:
|
Musculoskeletal system |
Unlimited referrals:
Benefits payable for each service on 3 occasions in 12 months:
Benefits payable for each service on 2 occasions in 12 month:
|
Cardiovascular system |
Benefits payable for each service on 2 occasions in 12 months:
Benefits payable for each service on 3 occasions in 12 months:
|
Body |
Benefits payable for each service on 1 occasion within 12 months:
|
Pelvis and upper abdomen |
Benefits payable on 1 occasion only:
|
Persons under the age of 16 |
Benefits payable for each service on 1 occasion in 12 months:
Benefits payable for each service on 2 occasions in 12 months:
Unlimited referrals:
|
Hunter Imaging Group scans patients that require shoulder and knee ultrasounds in accordance with the Medicare Benefits Schedule (MBS). In May 2003 the Health Insurance Commission issued amendments to the benefits payable for ultrasound of the shoulder and knee.
The amendments outline that Medicare will only rebate these examinations when the request form specifically includes one of the following suspected pathologies…
Shoulder Ultrasound
|
Benefits are payable when referred with suspicion of the following clinical conditions:
Benefits are not payable when referred for non-specific shoulder pain alone. |
Knee Ultrasound | Benefits are payable when referred with suspicion of the following clinical conditions:
Benefits are not payable when referred for non-specific knee pain alone or other known conditions including:
|
At Hunter Imaging Group we bill patients referred by Allied Health practitioners (Physiotherapists, Chiropractors, Osteopaths and Podiatrists) according to the Medicare Benefits Schedule (MBS).
The MBS states that these referrers’ patients are only entitled to a rebate when referred for the following selected examinations. If a patient presents with a referral for an examination that is not in the list below then they will be charged the private fee.
Physiotherapists, Chiropractors, Osteopaths
- X-ray hip
- X-ray Pelvis
- X-ray cervical spine
- X-ray thoracic spine
- X-ray lumbar spine
- X-ray sacrococcygeal spine
- Long spinal image or multiple spinal regions
Podiatrists
- Ultrasound ankle or hind foot
- Ultrasound mid or fore foot
- Ultrasound lump
- X-ray foot
- X-ray leg
- X-ray knee
- X-ray femur
- Long leg image for leg alignment or leg lengths
Nurse Practitioners
- Ultrasound Shoulder or Upper Arm (only available if suspected injury to tendon, muscle or muscle/tendon junction, rotator cuff tear, sublaxation of biceps, mass, occult fracture, or AC joint pathology)
- Interventional Musculoskeletal Ultrasound (only available when request states that US-guided intervention be performed only if clinically indicated)
- Ultrasound breast
- Ultrasound Chest or Abdominal Wall
- Ultrasound Forearm or Elbow
- Ultrasound Abdomen
- Ultrasound hip*, groin, buttock or thigh (*US exams for the evaluation of hip dysplaysia, spine and spinal cord are also available in paediatrics)
- Ultrasound Hand or Wrist
- Ultrasound Prostate (Prostate US only available if seen and recommended by a Urologist or Oncologist in the last 60 days)
- Ultrasound Knee (Knee US not available for non-specific conditions. Only in suspected issues with tendons or bursae, mass or cyst, nerve or collateral ligaments)
- Ultrasound Skin and Subcutaneous Structures
- Ultrasound Lower leg, ankle and foot
- X-ray Thoracic Inlet or Trachea
- X-ray Shoulder or scapula
- X-ray Clavicle
- X-ray Chest
- X-ray Ribs and sternum
- X-ray hand, wrist, forearm, elbow and/or humerus
- X-ray Pelvic girdle
- X-ray Hip joint
- X-ray femur, internal fixation or trochanteric fracture
- X-ray foot, ankle, leg ,knee and/or femur